COMPLICATIONS OF TONSILLECTOMY AND MANAGEMENT
With advancement in the operative techniques and anesthesia, the complications of tonsillectomy are greatly minimized.
1.Primary Hemorrhage: The bleeding during the surgery increases with previous peritonsillar abscess and scarring. However, the bleeding can be controlled by pressure, ligation and diathermy if required. This hemorrhage is called primary hemorrhage.
2. Reactionary Hemorrhage: Bleeding occurring within the first 24 hours called reactionary hemorrhage. This hemorrhage is usually due to:
- Wearing off effect of adrenaline used in infiltration.
- Slipping of ligature.
- Rise of blood pressure post-operative.
- Dislodgement of a blood clot from the lumen of the vessel.
3. Anesthesia complications.
4. Trauma: Damage to lips, teeth, gums, posterior pharyngeal wall, uvula and dislocation of temporomandibular joint may occur.
- Secondary Hemorrhage: This hemorrhage occurs classically from 5th to 8th day after surgery. The most common cause of bleeding is secondary infection.
- Pulmonary complications: Pulmonary atelectasis post operatively can lead to pneumonia, especially if the patient is suffering from upper respiratory tract infection prior to the surgery or has aspirated blood during the surgery.
- Infection of the tonsillar fossa causes increasing pain, fever and if untreated can cause secondary hemorrhage.
- Hematoma and oedema of the uvula due to surgical handling.
- Subacute bacterial endocarditis can occur due to transient bacteremia during surgery.
- Earache is usually at the onset of a tonsillar infection and sometimes after tonsilloadenoid resection. It is a referred pain from the tonsillar fossa.
- Scarring of soft palate and tonsillar fossa.
- Voice change with nasal twang can occur due to oedema and inflammation of the palatal muscles. This also occurs after adenoidectomy done along with tonsillectomy.
Management of tonsillar haemorrhage: